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Utilization Jobs (NOW HIRING)

Summit BHC

Utilization Specialist

Champaign, IL

Utilization Specialist | The Pavilion at Williamsburg Place | Williamsburg, Virginia About the Job: The Utilization Specialist is responsible for reviewing of assigned admissions, continued stays ...

Virginia Gay Hospital

Utilization Tech

Vinton, IA

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Utilization Tech/Nurse M-F 1st shift, 32 biweekly hours 8-4:30 Clinical background preferred About VGH Virginia Gay Hospital, established in Vinton in 1923, is an independent, nonprofit critical ...

Sutter Health

Utilization Coordinator

Santa Rosa, CA · On-site

$77.29 - $102.55/hr

Coordinates the utilization management, resource management, discharge planning, post-acute care referrals and care facilitation. Oversees the management of acute patient populations across the care ...

HealthCare Support

Utilization Management

Houston, TX · On-site

$38 - $42/hr

  • Medical

  • Dental

  • Life

RN Outpatient Utilization Review Remote Texas HealthCare Support is actively seeking multiple Outpatient Utilization Review Registered Nurses with our prestigious Healthcare Client. Applications must ...

Acadia Healthcare

Utilization Specialist

Henderson, NV · On-site

Proactively monitor utilization of services for patients to optimize reimbursement for the facility. Responsibilities ESSENTIAL FUNCTIONS: * Act as liaison between managed care organizations and the ...

Acadia Healthcare

Utilization Specialist

Murfreesboro, TN

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Join our team at TrustPoint Hospital as a Full Time Utilization Specialist! We are seeking passionate professionals that are dedicated to behavioral health. If you are looking for unparalleled growth ...

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All JobsUtilization Jobs

Utilization information

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$21

$42

$68

How much do utilization jobs pay per hour?

As of Aug 18, 2026, the average hourly pay for utilization in the United States is $42.28, according to ZipRecruiter salary data. Most workers in this role earn between $33.41 and $48.56 per hour, depending on experience, location, and employer.

What is a utilization specialist?

Utilization specialists are professionals who review and evaluate the necessity, appropriateness, and efficiency of the use of healthcare services, procedures, and facilities. They work closely with healthcare providers, insurance companies, and patients to ensure that care is delivered according to established guidelines and that resources are used effectively. Their goal is to help manage costs while ensuring patients receive the appropriate level of care.

What are some of the common challenges faced by utilization review specialists when assessing medical necessity of services?

Utilization Review Specialists often encounter the challenge of balancing patient advocacy with cost-effective care. They must stay updated on evolving insurance policies and clinical guidelines, which can be complex and change frequently. Additionally, coordinating with physicians and healthcare staff to obtain necessary documentation and clarifying treatment plans can be time-consuming. Strong communication skills and attention to detail are essential to ensure timely and accurate reviews, while also maintaining positive working relationships with clinical teams.

What are the key skills and qualifications needed to thrive as a utilization review specialist, and why are they important?

To thrive as a Utilization Review Specialist, you need a background in healthcare (often as an RN or LPN/LVN), strong analytical skills, and knowledge of insurance and medical necessity criteria. Familiarity with utilization management software, ICD-10/CPT coding, and regulatory guidelines like Medicare and Medicaid is typically required. Excellent attention to detail, critical thinking, and effective communication skills set top performers apart in this role. These abilities are crucial to accurately evaluating patient care needs, ensuring regulatory compliance, and optimizing resource use within healthcare organizations.

What is the difference between Utilization vs Resource Coordinator?

AspectUtilizationResource Coordinator
Primary FocusMeasuring and optimizing how staff time is usedManaging and assigning resources for projects
Required CredentialsOften no specific credentials, but industry experience helpsTypically requires organizational or project management skills
Work EnvironmentCorporate, healthcare, or consulting firmsProject teams, staffing agencies, or departments
Common UsageTracking staff utilization ratesAllocating resources to projects or tasks

Utilization focuses on measuring how effectively staff time is used, often to improve productivity. Resource Coordinator involves actively managing and assigning resources to ensure project needs are met. While related, utilization is more about analysis, and resource coordination is about execution and management.

How to become a utilization reviewer?

To become a utilization reviewer, candidates typically need a background in healthcare, nursing, or a related field, along with knowledge of medical coding and insurance policies. Relevant certifications such as Certified Professional Coder (CPC) or Certified Medical Reimbursement Specialist (CMRS) can enhance job prospects. Strong analytical skills and attention to detail are essential for reviewing medical records and determining appropriate service utilization.
More about Utilization jobs

What cities are hiring for Utilization jobs?

Cities with the most Utilization job openings:

What are the most commonly searched types of Utilization jobs?

The most popular types of Utilization jobs are:

What states have the most Utilization jobs?

States with the most job openings for Utilization jobs include:

Utilization jobs near you
Infographic showing various Utilization job openings in the United States as of August 2026, with employment types broken down into 2% As Needed, 87% Full Time, 9% Part Time, and 2% Contract. Highlights an 90% Physical, 3% Hybrid, and 7% Remote job distribution, with an average salary of $87,946 per year, or $42.3 per hour.

Utilization Specialist

The Refuge, A Healing Place

Ocklawaha, FL • On-site

$20/hr

Full-time

Posted 26 days ago

Job description

Overview

The Refuge provides premier residential treatment for adults aged 18 and older who are struggling with substance use disorders, behavioral health, trauma, eating disorder and other co-occurring disorders. 

We are looking to for a Full Time Utilization Review Specialist to join our team. The UR specialist proactively monitors utilization of services for patients to optimize reimbursement for the facility. This is a Monday-Friday, day position working 40 hours per week.

PURPOSE STATEMENT: 

Proactively monitor utilization of services for patients to optimize reimbursement for the facility.  

Pay for this position starts at $20/hr and based on relevant work experience.  Higher starting wages for candidates that meet the preferred education criteria will be discussed.

Preferred education:  Associate's, Bachelor's or Master's Degree in Social Work, Behavioral or Mental Health, Nursing, or a related health field.

Required experience:  Clinical experience is required, 2 or more years experience working in the behavioral health field.  Previous experience in utilization management is strongly preferred.

Responsibilities

ESSENTIAL FUNCTIONS: 

  • Act as liaison between managed care organizations and the facility professional clinical staff. 
  • Conduct reviews, in accordance with certification requirements, of insurance plans or other managed care organizations (MCOs) and coordinate the flow of communication concerning reimbursement requirements. 
  • Monitor patient length of stay and extensions and inform clinical and medical staff on issues that may impact length of stay.  
  • Gather and develop statistical and narrative information to report on utilization, non-certified days (including identified causes and appeal information), discharges and quality of services, as required by the facility leadership or corporate office. 
  • Conduct quality reviews for medical necessity and services provided.   
  • Facilitate peer review calls between facility and external organizations.  
  • Initiate and complete the formal appeal process for denied admissions or continued stay.  
  • Assist the admissions department with pre-certifications of care.  
  • Provide ongoing support and training for staff on documentation or charting requirements, continued stay criteria and medical necessity updates. 

OTHER FUNCTIONS:  

  • Perform other functions and tasks as assigned. 
Qualifications

EDUCATION/EXPERIENCE/SKILL REQUIREMENTS: 

  • Required Education: High school diploma or equivalent. 
  • Preferred Education: Associate's, Bachelor's, or Master's degree in Social Work, Behavioral or Mental Health, Nursing, or a related health field. 
  • Experience: Clinical experience is required, or two or more years' experience working with the facility's population. Previous experience in utilization management is preferred 

LICENSES/DESIGNATIONS/CERTIFICATIONS:  

  • CPR and de-escalation and restraint certification required (training available upon hire and offered by facility.   
  • First aid may be required based on state or facility requirements. 

 

ADDITIONAL REGULATORY REQUIREMENTS: 

While this job description is intended to be an accurate reflection of the requirements of the job, management reserves the right to add or remove duties from particular jobs when circumstances  (e.g. emergencies, changes in workload, rush jobs or technological developments) dictate. 

We are committed to providing equal  employment opportunities to all applicants for employment regardless of an individual's characteristics protected by applicable state, federal and local laws.

REFHP

Employment Type: FULL_TIME

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